Individual
AMANDA ALICE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
671 SW MAIN ST, WINSTON, OR 97496-6571
(458) 802-7028
Mailing address
4760 RESTON RD, ROSEBURG, OR 97471-9759
(541) 238-3887
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6381
OR
Other
Enumeration date
03/21/2018
Last updated
03/21/2018
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